Developmental Disabilities Administration Waiting List Initiative FY 12

1. Developmental Disabilities AdministrationWaiting List Initiative FY 12 Provider Training August 26, 2011

2. Today’s Agenda • Overview • Status of People Targeted • Action Plan • Capacity • Streamlined Service Initiation • Fiscal Process • Individual Plan • Services of Short Duration • Waiting List Initiative Tracking and Monitoring

3. Senate Bill 994 “Sales and Use Tax – Alcoholic Beverages – Supplementary Appropriation • Provides $15,000,000 to fund a Waiting List initiative for the Developmental Disabilities Administration (DDA) for fiscal year 2012 • The funds are to supplement the DDA’s fiscal year 2012 appropriation. • Priorities are for people on the DDA Waiting List in the Crisis Resolution and Crisis Prevention priority categories. • Effective July 1, 2011.

4. Guiding Principles • Spend the funds as legislature intended: funding services for people in the crisis resolution and crisis prevention categories. • Given the significant unmet need, spend $15 million to serve people with developmental disabilities. • Maximize the use of State General funds with a federal match.

5. Who Provided Input?

6. Proposed Stages of Implementation Stage 1 of Implementation July 2011 – January 2012 • Place everyone in Crisis Resolution in appropriate services. • People in the Crisis Prevention category would be reminded of the criteria for the Crisis Resolution category and reassessed as appropriate. • Offer funding this fiscal year for services of short duration to people in the Crisis Prevention category.

7. The DDA Waiting List DDA Waiting List information reflected below is data as of July 1, 2011

8. People in Crisis Immediate need for services

9. Crisis ResolutionMay 2011 - August 2011 Data reflects unduplicated people and service initiation status reported as of August 25, 2011.

10. Current People in Crisis Resolution Traditional Service Initiation Status Note: Data as of August 25, 2011.

11. Services Initiated Note: Data as of August 10, 2011 based on service funding plan. Data reflects duplicative counts as people access more than one type of service model.

12. Waiting List Crisis Resolution by Service Request People in Crisis Resolution 72 Day Supports 38 Supported Employment, Community Learning Service, Employment Discovery and Customization, Day Habilitation Residential Supports 40 Alternative Living Units (ALU), Group Homes, Individual Family Care (IFC), and Community Supported Living Arrangement (CSLA. Individual Supports 11 Individual Support Services and Family Support Services Services data are duplicative counts of people as many express interest in some or all of the service categories available for funding. Data as of August 25,2011

13. People Expected to Join Crisis Resolution Category During Fiscal Year 2012 • We estimate that eleven (11) people will become eligible for the crisis resolution category each month

14. Waiting List Crisis Prevention by Service Request People in Crisis Prevention 1139 Day Supports 654 Supported Employment, Community Learning Service, Employment Discovery and Customization, Day Habilitation Residential Supports 633 Alternative Living Units (ALU), Group Homes, Individual Family Care (IFC), and Community Supported Living Arrangement (CSLA) Individual Supports 509 Individual Support Services and Family Support Services Services data are duplicative counts of people as many express interest in some or all of the service categories available for funding. Data as of July 1, 2011.

15. Waiting List Initiative Action Plan • Resource Coordination services for people identified • People in Crisis Resolution to receive comprehensive services under this initiative • Immediately triaging emergency services (i.e. respite, behavioral supports, in home supports, etc.) • Planning for long term supports strategies (i.e. vocational and residential supports) • People in Crisis Prevention to receive service of short duration (i.e. FSS or ISS)

16. Statewide Providers Capacity Assessment • MACS and non-MACs providers surveyed • Ability to provide immediate services (to address crisis) • Interest in expanding

17. Provider Capacity Survey Results 89 Total surveys returned (44% of all DDA licensed providers) 33 Central / 24 Southern 18 Western / 14 Eastern 22 Providers indicated an interest in expanding services Some interested in expanding into other regions

18. Providers Interested in Expansion by County

19. Estimated DDA Licensed Provider Capacity (Excluding RC)

20. Statewide Resource Coordination Capacity Assessment • Survey sent to Resource Coordination providers regarding current FTEs

21. Resource Coordination Capacity • Priority for Resource Coordination realigned for people on the Waiting List • Everyone in Crisis Prevention (except in Montgomery County) has a Resource Coordinator or will be assigned as identified. We are working with Montgomery County to assure services.

22. Waiting List Initiative Streamlined Service Initiation Process

23. Waiting List Initiative Commitment • Commitment to: • Expedite processing • Tracking/Reporting • Triaging emergency services • Piloting new IP module

24. Basic Changes to Service Initiation Process Streamline key activities such as : • Initial assessment of need • Critical Needs List Recommendation • Matrix Assessment • Plan development • Fiscal Processes • Expedited funding protocol to determine funding allocation amounts and disbursement to support people to begin services as quickly as possible. • Individual Plan versus Service Funding Plan

25. Week 1 : Service Initiation Process for Alcohol Tax Waiting List Initiative DAY 1 DAY 2 DAY 3-4 DAY 5-6 DAY 7

26. Week 2: Service Initiation Process for Alcohol Tax Waiting List Initiative SERVICES CAN NOW BEGIN DAY 8 DAY 9 DAY 10 DAY 12 DAY 13 DAY 14

27. Fiscal Process • Expedited Funding • Authorization Document • Waiting List Initiative Funding Authorization Letter • Individual Plan

28. Expedited Funding Proposal Waiting List Initiative Funding Authorization • Given to the person and Resource Coordinator to share with the provider • Commits to funding for services • Authorizes base levels of funding • May include: • Support services • Day Habilitation/Supported Employment services • Residential /CSLA services • Residential services will also include service initiation funds • Funding allocations will be adjusted (as appropriate) after Individual Rating Scale (IIRS) is completed

29. Support Services Funding ProposalBefore a long-term service provider is selected • Can be used as a triage strategy and long-term support • Immediate services to address crisis needs with long-term planning • Amount of allocation determined by: • FY 11 Family and Individual Support Services (FISS) allocations • County where services are provided

30. Initial Residential Services Funding Determinations • People may choose: • Existing DDA licensed site • New DDA licensed site • Initial base budget at a minimum = approx.$35,000 • Based on county of residence • Up to an additional $5,000 for transitional supports • Additional monies for transportation services may be included Transportation services include supporting the person in learning how to access and utilize informal, generic, and public transportation for independence and community integration. • $5,000 - $7,500 based on accessibility needs

31. Initial Day Habilitation and Supported Employment Services Funding Determinations • Initial base budget of $12,000 • Based on county of residence • Additional monies for transportation services may be included Transportation services include supporting the person in learning how to access and utilize informal, generic, and public transportation for independence and community integration • $5,000 - $7,500 based on accessibility needs

32. Pilot Individual Plan • Propose piloting new shorter, streamlined document • Proposed plan includes outcomes, service scope, frequency, duration, provider, and funding • Also includes initial triage services, long-term service plans, and accessing generic/community services • Serves as a legal contract for other Medicaid waiver programs • Propose to use in lieu of service funding plan

33. Services of Short Duration

34. Services of Short Duration Target Group – People in Crisis Prevention Guiding Principle - Given that people on the DDA Waiting List in the Crisis Prevention category are at risk of crisis within one year, provide funding during FY 12 for services and/or supports to address and prevent the crisis from occurring.

35. Proposed Approach • Provide funding for services and supports that address the immediate crisis trigger(s) • One time only (e.g. payment of outstanding utility or medical bills, etc.) or • Services of short duration (i.e. respite services, behavioral support services, etc.) • 2. If needed, provide funding for intervention services to support the person or family to prevent future crisis or the reoccurrence of the crisis

36. Information for People and Families • Send letters informing people of the ability to access funding for services and assistance available. • Develop “frequently asked questions” document and post on DDA website. • Provide user friendly guide for people and families to understand intent of services, supports available, and resources available (i.e. DDA licensed providers, local services, funding, etc.).

37. Support for People and Families • Provide assistance for people and families via DDA to identify service and support needs, service providers, and assist with request submission. Assistance with this can be obtained from: • Resource Coordination providers • Low Intensity Support Services providers • Family and Individual Support Services providers

38. Service Examples Services of short duration should be individualized, simple, meaningful, and address the immediate crisis need or trigger(s). Examples include:

39. Funding Guidelines • Provide up to $10,000 per person to address the immediate crisis trigger(s) and intervention services. • Provide funding for services to both DDA and non-DDA licensed service providers. • Commitment and payment of funding until • June 30, 2012. Services funded may carry over into next fiscal year. • Utilize an exception protocol to meet unique needs or circumstances.

40. How Will People Access Funds? • Plan for crisis needs with assistance from Resource Coordinator, Low Intensity Support Services (LISS) provider, or Family and Individual Support Services provider • Complete a simple Services of Short Duration Funding Requestform • Submit the form to a LISS provider who will administer funding for services of short duration

41. Analysis and Expansion • Expand targeted group for services of short duration based on tracking and analysis of actual and projected expenditures under the initiative • Evaluate the impact of the funding

42. Projected Funds Available for Services of Short Duration in FY 12 The estimate for available funds for Crisis Prevention is based on the difference between $15 million minus $9.2 million (the projected general fund cost to support people in crisis resolution during the fiscal year).

43. Services of Short Duration Target Group – People on DDA Waiting List in Crisis Prevention priority category DDA Waiting List data as of July 1, 2011

44. Potential Numbers of People Who Could Receive Funding • Minimum - 580 people • This calculation is based on the 580 people utilizing the full $10,000 funding allocation. • (580 people x $10,000 = $5.8 M) • Maximum - 1,096 people • This calculation is based on the 1,096 people utilizing FISS cost mode of $5,290. • (1096 people x $5290 = $5.79 M) • Estimates are based on funding for services and supports that address the immediate crisis trigger and intervention services only. • Note: FISS Mode based on FY 10 data

45. Waiting List Initiative Tracking and Monitoring •  When assigned a Resource Coordinator • When Funding Authorization Letter sent • When needs assessed (Matrix) • When Individual Plans (IPs) completed • When services started as designated in their IP

46. Questions